This study was of a qualitative nature and was proceeded by a pilot study [10,11]. It was approved by the Research Board of the National Institute of Public Health. The study protocol guaranteed voluntary participation and the anonymity of all experts. Informed consent was obtained from all participants. Opinions were obtained from a broad group of experts and practitioners throughout Poland whose views might be helpful in advancing the development of a blood-borne infection prevention program. The following topics were focused on: the problem of reducing the risk of infections in services/procedures connected with abrasion and damage of tissues, and the risk associated with the spread of infections and protection of staff and clients/patients.
The data obtained were divided into four topic areas related to the following: organization and management, legislation and regulations, education, and financing. Three groups of experts were invited to participate in this research project: practitioners, employees of supervising authorities (administrative supervision) at the regional level and policy-makers at the national level (central), and opinion leaders. A qualitative study was carried out in the form of a two-panel internet discussion, and a focus group interview (FGI) was conducted with each of those groups. These tasks were outsourced to an independent research agency that performed them using an online tool (IdeaBlog).
The information collected together with supporting data (i.e., statistical figures, information on program implementations, results of supervision, control over the healthcare and nonmedical services sector, etc.) does not reflect only the status of social awareness. The substantial results of the project on blood-borne infections provided up-to-date and extensive research output material clarifying various aspects of infection risk in both healthcare and nonmedical services by considering many perspectives. Data obtained at the subsequent stages of the project represented the opinions of service providers, clients, and public payers of services and were used to select and identify priorities (Figure 1). This was essential in developing the proposed assumptions for the blood-borne infection prevention strategy.
Procedure
Identification of the problem
The first stage of this research project was carried out between July 18 and August 20, 2016. The following practitioners were invited during this stage: experts, epidemiologists, and service providers whose daily work is associated with the risk of blood-borne infections—both exposure to the risk and risk generation. The perspective of an authority that controls the observance of regulations regarding the minimization of that risk, i.e., Sanitary Inspectorate, was also obtained. They were invited using a list prepared by the National Institute of Public Health; the official invitation contained a presentation of the research project, its objectives, and a kind request to participate in it. Anonymity was guaranteed to all participants. Of the 80 people who were invited, 42 participated in an internet forum for five days. The main reason for refusal to participate in the study at each stage was an excessive number of other obligations, which made it impossible for them to be completely involved in the project. Throughout the study period, the invited experts were given two questions every day through which they were asked for their opinions. For each task, the necessity to support answers with evidence was emphasized; for example, from practice, figures, statistical data, and particular examples reflecting problems and good practice. The results thus collected were verified through supported material, and they constitute an extensive collection of research material that was arranged in a SWOT analysis and used in a form verified for the subsequent second stage.
Identification of the process and proposed solutions
At the second stage, the following representatives of supervising authorities participated in the study: representatives of state administration authorities, medical center managers, experts from academic centers, and specialists and experts in the field of public health. Of the 125 people invited to participate in the second stage of this research project, 41 took part in it. The research methods were similar to those used in the first stage; however, the profile of the group of experts was different. Information was gathered between September 5 and November 7, 2016. Participants received one topic per day for five days and were asked to express their opinions regarding the topics. Figures and data collected this way and verified (from the first stage and from the second stage) constituted a basis for the subsequent analysis: information selection and emergence of new aspects from the perspective of risk management. In the analysis, the obtained information was assigned to the following topics: management, legislation, education, and financing. The information was synthesized, and 33 postulates were proposed that formed the basis of discussion for the third stage of this research project.
Priorities of tasks and problems
An FGI that summed up the first and second stages of this study was completed on November 30, 2016, at the National Institute of Public Health in Warsaw. FGIs are a qualitative method used to discuss particular themes in a group of invited participants in an open atmosphere; the proposed scenario was prepared earlier [12,13]. The meeting was attended by opinion leaders—representatives of patients, service providers, public payers, the Agency for Health Technology Assessment and Tarification, and the Ministry of Health. Participants did not have to represent similar standpoints; the purpose of the meeting was not to identify solutions but to understand various perspectives so that they could be considered at a later research stage. The meeting was discussion-oriented and not debate-oriented, despite the existence of many sensitive areas. There was a moderator whose role was to create conditions favorable for discussion. Since this was supposed to be a panel discussion with a group of key decision-makers to sum up the two earlier stages of this research project, based on the findings obtained in the earlier stages, 33 proposed solutions were prepared (divided into four categories: legislative, educational, organizational, and financial) and sent by e-mail to the experts invited to the discussion before the meeting so that they could adequately prepare for the discussion. At the meeting, participants were asked to prioritize the 33 proposed solutions.
Fig. 1. Project Scheme – Research Project Stages
In the third stage, 26 postulates were adopted and prioritized according to the credits assigned to them by respondents. In this way, the problem-postulates were assigned a rank. In the first group of most important priorities, i.e., high number of credits (11-18), four postulates were included. In the second group of moderate priorities (4-7 credits), there were seven postulates. Finally, in the third group of low importance (1-3 credits), 15 postulates were included and seven were rejected. In addition, in the prioritization of tasks, like in the earlier stages of the research project, the adopted topic areas were allocated into legislation, education, organization, and finance.